Operating table apparatus for gravity exposure of the heart



uly 28, 1959 B. MAISEL 2,897,029

OPERATING TABLE APPARATUS FOR GRAVITY EXPOSURE OF THE HEART Filed April9, 1958 2 Sheets-Sheet 1 IIIIIIIIIIII=I1 II 1 l IIIIIIIIIIIIIIII-IIII'II II I INVENTOR. BERNARD MAISEL.

BY uxkmmum m So\\onk ATTORNEYS B. MAISEL July 28, 1959' OPERATING TABLEAPPARATUS FOR GRAVITY EXPOSURE OF THE HEART Filed April 9, 1958 2Sheets-Sheet 2 BY (mam ,om'm k 6 Qe mxk.

ATTORNEYS United States Patent OPERATING TABLE APPARATUS FOR GRAVITYEXPOSURE OF THE HEART Bernard Maisel, Englewo'od, N.J., assignor ofone-half to Cornell Research Foundation, Inc., Ithaca, N.Y., andone-half to New York Heart Association, Inc, New York, NY.

Application April 9, 1958, Serial No. 727,472 6 Claims. (Cl. 311-7) Thisinvention relates to operating table apparatus particularly suited foruse in surgery involving gravity exposure of the heart. The illustrativeembodiment of the invention described herein as an example is operatingtable apparatus which is particularly suited for supporting a patient inprone position so as to enable the surgeon to utilize the force ofgravity for exposing the patients heart in a positionespecially'convenient for surgery upon the rear portions or vessels ofthe heart or for exposing the entire surface of the heart for treatment.

In certain types .of heart operations involving exposure of large areasof the heart or involving regions or vessels of the heart at or towardthe back, one of the major problems faced by the surgeon is thedifiiculty of obtaining adequate and efiicient access to the posteriorportions and vessels of the heart. In operating techniques suggestedheretofore wherein the patient lies face up upon the operating table, itwould be necessary for the surgeon to lift up or support the heartmanually while reaching in through a large incision in the chest inorder to obtain access to the posterior portions of the heart for thenecessary treatment. This lifting and supporting of the heart so as toreach down in and underneath it would involve extensive manual handlingof the heart during the course of an operation and would be an extremelydelicate and exacting procedure and one which would be very diflicult tocarry out. In any procedure which wouldcall upon the surgeon to lift andsupport the heart while reaching in under it and while the heartcontinues to beat, the surgeon would find that it is impossible to applyand maintain a uniform supporting force upon all areas of the heart overa length of time as required for surgery. Experiments upon animals haveshown that this type of supporting and reaching underneath the heartcauses irregular and undue stimulation of the heart. As a result theheart is likely to stop beating during the operation, or it may lapseinto an erratic beating pattern which causes death within an hour or twoafter completion of the operation. Moreover, the necessity of supportingthe heart requires the use of one hand and interferes with the visionand access required for surgery upon the underneath portion of theheart. Thus, it will be appreciated that an attempt to perform surgeryupon the parts or vessels of the heart at or toward the back when thepatient is lying face up involves three serious difficulties: (1) theheart itself is likely to be irregularly and unduly stimulated, (2) thesurgeon has only a very limited field of vision and limited access withonly one hand, and (3) a very large incision is required so as toprovide even a minimum, although not satisfactory, field forsimultaneously supporting and operating upon or near the rear of theheart.

The present inventor has also conceived and evolved an entirely newtechnique and approach to the problem of surgery upon posterior parts orvessels of the heart. In this new technique the extent of the incisionand the dislocation of adjacent muscles, bones and organs is reduced toa Further, and of extreme impor- 7 2,897,029 Patented July 28, 1959tance, it is no longer necessary for the surgeon to handle the patientsheart in order to remove that organ from its natural position within thebody of the patient when the entire heart must be exposed for treatment.In this new technique the patient is placed in a face down and proneposition. The fifth rib on the left side is removed, and the fourth andsixth ribs are severed near the spinal column in such a way that theywill readily heal back. Then the fourth and sixth ribs are spread apartto provide an opening in the front and side of the patients chest. Thepatient is then tipped or rotated by inclining the operating tableapparatus of the present invention so as to lower the left side of thepatient by an angle of approximately 12 up to 18. As the heart beats,the force of gravity urges the heart so as to shift it and move it downout of the cavity. The beating motion of the heart aids in gentlychanging its position so that it soon hangs exposed from the patientsbody suspended and supported by its great vessels which are attached tothe top of the heart. Thus, there is no necessity for the surgeon tohandle the heart and the possibility of injury to the heart during suchhandling is eliminated.

Accordingly, it is an object of the present invention to provideoperating table apparatus which facilitates the practice of an operatingtechnique wherein the patients heart is exposed by gravity after aminimum of surgery. It is another object to provide such operating tableapparatus which may be inclined -and,-thus, manipulate the body of thepatient so as to accomplish the gravity exposure of patients heart andwhich yields convenient access to the patients heart when suspended. Itis a further object to provide operating table apparatus for gravityexposure of the heart which may, if desired, be 'used as an attachmentin conjunction with an operating table of the general type which isfound in most hospitals. It is a still further object to provideoperating table apparatus which may be made collapsible and which may beeasily stored when not in use. 1

In this specification and the accompanying drawings a preferredembodiment of the present invention in operating tables is shown anddescribed which is particularly suited for gravity exposure of theheart. It is to .be un derstood that this is not intended to beexhaustive nor a limiting of the invention, but, on the contrary, it isdepicted for the purpose of illustration in order that others I skilledin the art may fully understand the invention, its principles and themanner of carrying it out.

A more complete understanding of the invention and of further objectsand features thereof, can be obtained from the following detaileddescription of the illustrative embodiment thereof, which is to be readin connection with the accompanying drawings, wherein:

Figure l is a perspective view of gravity exposure heart operating tableapparatus in accordance with the present invention and shown being usedin conjunction with a standard operating table,

Figure 2 is a diagrammatical sectional view showing the heart operatingtable apparatus in a substantially horizontal position;

Figure 3 is a diagrammatical sectional view showing the heart operatingtable apparatus in a position wherein it is inclined to the right;

Figure 4 is a diagrammatical sectional view showing the heart operatingtable apparatus in a position wherein it is inclined to the left;

Figure 5 is a plan view of the heart operating table apparatus;

Figure 6 is a longitudinal side elevational view of the apparatus;

Figure 7 is an end elevational view of the apparatus;

Figure 8 is a sectional view, on enlarged scale, showing the clampdevice for seeming the legs of the. heart operating table apparatus to aside rail on a standard operating table; this view is taken along thedirection of the arrows 8--8 of Figure 6; and

Figure 9 is a top view of the clamp device on the same scale as Figure8.

Referring to the drawings and to Figure 1 in particular, operating tableapparatus for gravity exposure of the heart is generally indicated at 10in accordance with the present invention, and this illustratedembodiment of the invention is adapted to be used in conjunction with anoperating table 11 of the type generally found in most hospitals. Theheart operating table apparatus 10 (hereafter called the heart table)has a head platform portion 12 and a foot platform portion 14 which areconnected together by a bridge member 16. The head and foot portions aresupported andspaced above the top 18 of the standard table 11 by meansof a series of side legs 20 and a pair of center supporting posts 22which apply additional supporting force to the respective platforms atpoints near the ends of the bridge member 16.

The top 18 of a standard operating table is customarily about 24 inchesin width, but for the heart table it is advantageous to use a width inthe range from to inches, and 18 inches has been found to be the optimumvalue for this type of heart table. It has also been found that a headportion 24 inches long and a foot portion 36 inches long are quitesuitable.

The construction of the heart table 10 is explained inmore detail inconnection with Figures 5, 6 and 7. As shown therein, the head and footportions 12 and 14 are connected together by the bridge 16, which isdetachable from the head portion and telescopes within the foot portion.The head end of bridge 16 is attached to a cross member 24 and the footend of the bridge is attached to a similar cross member 25. These crossmembers 24 and 25 have L-shaped bent end portions 26, each with a set ofholes 28 therein. Each set of holes 28 is spaced apart the same distanceas similar holes 30 which are located in a skirt flange 32 which isturned down all around the perimeter of the head portion 12 and in asimilar skirt flange 34 of the foot portion 14.

To enable adjustment of the overall length of the heart table 10, thebridge member slides in telescoping relation through a slot 35 in theskirt flange 34, and the holes 28 in the L-shaped ends of the crossmember 25 are matched with a selected pair of the series of holes 30 inthe skirt flange 34 of the foot portion 14. This adjustability of thelength of the heart table 10 permits the spacing between the head andfoot portions 12 and 14 to be enlarged or reduced as desired in order toaccommodate patients of various heights.

In order to disconnect the head end of the bridge 16 from the headplatform, a pair of 'wing bolts 37 are unfastened so as to release theend of thebridge from the cross member 24. Then the end of the bridge iswithdrawn through a slot 39 in the skirt flange. This head end of thebridge is bent over to accommodate a hole for the wing bolts 37, but canbe withdrawn through the slot by suitably moving the head platform.

The head and foot portions 12 and 14 are spaced above the top 18 of thetable 11 by the legs 20- and the posts 22. In actual practice it hasbeen found that a height of 18 inches between the top 18 of table 11 andthe top of the heart table 10 is most satisfactory. Since the table 11itself is supported on a base 19 and may be raised or lowered and thetop 18 inclined to the right or left by hydraulic control means 21, theelevation and angle of the heart table 10 may be changed by suitablyadjusting the standard operating table 11.

The posts 22 are detachably mounted on each of the cross members 24 and25 by screwing into sockets 41 and foot plates 36 are attached to thebottom of the posts 22 to spread the load carried by the posts insupporting the central region of the heart table 10.

In the illustrated embodiment, each set of supporting legs 20 is madefrom a single length of flat bar stock which is bent to provide aninverted U-shaped support frame 33 comprising the legs 20 and a centersection 38. This center section 38, in addition to connecting the legs20 also supports the top flat area of the head and foot portions 12 and14.

The ends 40 of the legs 20 are bent inwardly to form flat shoes andthese rest on the top 18 of table 11 near the edge. These shoes 40 areeach associated with an outwardly and downwardly projecting arm 42attached to the lower part of each leg 20 so as to secure and tostabilize the heart table 10. The arms 42 diverge from the legs 20 andextend below the top 18 of the table 11 where they are received inclamping sockets as will be explained.

As shown in Figure 1 in particular, a rail 44 runs along each side ofthe table 11 and a series of mounting clamps 46 are slidably attached tothis rail. The end of each arm 42 is inserted down into a recess in arespective one of the clamps 46 and fastened therein as shown in Figures8 and 9 by a clamp screw 47. Because the clamps 46 are held locked inplace on the rails 44 by the clamp screws 47, they also serve to fastenthe arms 42 and the support frames 33 securely to the table 10'.

A gusset plate 50 is provided at the top of each leg 211*. This gussetplate 50 has a pair of holes 52 therein which match with similar holes54 in the skirt flanges 32 and 34. Suitable fastening means are fittedinto the holes 52 and 54 to secure the frames 37 to the head and footportions 12 and 14. Thus, the head and foot portions are securely, butdetachably, connected to the frames 33 which, in turn, are securelyfastened to the table 10 by the slide clamps 46, 47.

It will be appreciated that it is advantageous to have the varioussupporting components of the illustrated heart table apparatusdetachable so that the apparatus may be readily disassembled andconveniently stored when not in use.

As stated previously, this invention in operating table apparatusprovides means for carrying out the new heart operating techniqueoriginated by the present inventor. In order to appreciate theadvantages of the present invention it may be helpful to have a moredetailed explanation of the utilization of the apparatus in conjunc tionwith this new surgery method carried out by using the present invention.In this new technique the patient is placed in a prone and face downposition on the heart table 10, which advantageously has a width withinthe range specified, so that normally a few inches of the patients torsohangs over each side of the heart table 10. The head, shoulders and thevery upper part of the chest is supported by the head platform portion12. The chest and mid-section of the patient is supported on the bridge16.

To insure that pressure on the patient is uniform a soft cushion such asa rolled wash blanket is placed beneath the patient along the bridge 16.The legs and the lower portion of the patients torso are supported onthe foot portion 14. To assure that the pressure on the body parts isuniform, in addition to the wash blanket on the bridge 16, cushions arealso placed beneath the patients head, knees and ankles. The patient isheld in position on the heart table 10 by means of straps 56 which arerun across the patients shoulders, pelvis and knees.

By having the heart table 10 divided into two major platform portions 12and 14 and connected by a narrow bridge 16, a large and freelyaccessible work space is provided about the patients chest. This largework space permits the surgeon to have easy access to the heart as ithangs suspended from the chest cavity.

With the patient in position the surgeon is ready to perform thenecessary surgery to obtain access to the a) heart as explained above sothat the heart is exposed, but it remains in the chest cavity. In orderto remove it from this cavity in order to treat it, the heart table isrolled over from the horizontal position of Figure 2 so as to inclinedownwardly toward the left. The necessary angle of incline will varywith different cases, but will be of the order of 12 to 18 or 20.

With the patient in an inclined position the force of gravity and thenatural pumping action of the heart causes that organ to drop from itsnatural cavity within the patients body. The heart then hangs, supportedby the great vessels at the top of the heart which have sufficientstrength to support the heart adequately. The selfsupported heart is nowavailable to the surgeon who has obtained full access to it without thenecessity of handling it.

Following the operation, the heart table is gently rolled over the otherway so that gravity and the pumping action of the heart will urge itback again into the chest cavity.

In the above description it was assumed that the surgeon particularlywished to have access from the left of the patient. It will be notedthat the bridge 16 acts as a support for the patients sternum, and thatthe right side of the body is also readily accessible. When the surgeonparticularly wishes to obtain access from the right, then the incisionis made in the right side. The neart 1s then exposed through thisopening on the right by gravity action by racking the patient so as tobe inclined downwardly on the right by a similar angle in the range from12 up to 18 or 20. The heart is returned to its normal positionfollowing the operation by racking the heart table gently over theopposite way.

During the operation, while the heart hangs suspended beneath the hearttable, the surgeon may conveniently rest his elbows on the surface ofthe standard operating table 11.

I claim:

1. Operating table apparatus for use in gravity exposure operationscomprising first and second spaced platforms in a common plane, saidplatforms having a width of from to inches, a narrow bridge memberextending longitudinally between said platforms, said bridge memberbeing detachable from one of said platforms and telescoping within theother platform, first and second pairs of legs depending from oppositesides of said first and second platforms, respectively, each of saidlegs including a foot portion adapted to rest upon the top surface of anoperating table for supporting said platforms, and an arm portionextending outwardly and downwardly from each leg below the level of thefoot portion thereof,

each arm portion being adapted to be clamped to theside of the operatingtable for stabilizing the position of the leg, and a supporting elementextending down from at least one of said platforms adapted to rest uponthe top surface of an operating table for applying supporting force tosaid platform at a point near to the juncture with said bridge member.

2. An operating table for use in the performance of gravity exposureoperations on the heart and comprising an upper table, a lowersupporting table, a rotating device and a support base, said upper'tablehaving head and foot portions joined by a narrow connecting member, saidupper table being mounted on and above said supporting table and saidhead and foot portions being narrower than said supporting table, saidsupporting table being rockably attached to said support base wherebysaid support table and upper table may be rotated about a longitudinalhorizontal axis with respect to said base so that the plane of the topof said upper table is inclined with respect to the horizontal plane ofsaid support base.

3. An operating table for use in the performance of gravity exposureoperations onthe heart comprising a pair of operating support platformsat each end having a narrow bridgemember spanned therebetween andcontrol means for rotating said pair of operating support plat forms andbridge member about their longitudinal axis.

4. An operating table for use in the performance of gravity exposureoperations in the chest for supporting the patient face down comprisingfirst and second spaced platforms in a common plane, a narrow bridgemember extending between said platforms and adjustably secured to andtelescoping within one of said platforms for adjusting the spacingbetween said platforms, and control means for rotating said first andsecond platforms and said narrow bridge member about a longitudinal axisfor lowering one side of the table with respect to the other side,thereby to facilitate the gravity exposure.

5. An operating table for use in the performance of gravity exposureoperations of the heart comprising an upper operating platform having asubstantial reduced central portion therein, side supporting legs beingattachable to clamps positioned along a second table set be neath saidupper table, support means for said second table, and a controlmechanism for rotating said second table attached thereto, said upperoperating table being spaced from said second table by said side legs.

6. An operating table for use in the performance of gravity exposureoperations as defined in claim 5 and including additional supportmembers for said upper table adjacent said central portion and inload-bearing contact with said second table.

References Cited in the file of this patent UNITED STATES PATENTS1,042,252 Myers Oct. 22, 1912 1,882,121 Collins Oct. 11, 1932 2,556,362Crumpler June 12, 1951 2,660,495 Schwalbe Nov. 24, 1953 OTHER REFERENCESTower Co., 'Inc., P.0. Box 3181, Seattle 14, Wash, Feb. 21, 1951.

